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Abortive Tubal Stump Pregnancy: Two Case Reports with Diagnostic Challenges and High Risk of Persistent Ectopic
Yanhong Zhao1, Jianhong Gao1, Donglei Xu1
1Department of Gynecology, The People's Hospital Of Langfang City, Langfang, People's Republic of China.
Background:
Tubal stump pregnancy(TSP) is a rare ectopic pregnancy that occurs in patients after salpingectomy. We report two cases of a distinct clinical subtype characterized by spontaneous detachment of gestational tissue from the tubal stump, which we describe as "abortive TSP".
Cases:
Two patients with a history of salpingectomy presented with abdominal pain and positive β-hCG. Case 1 was conceived naturally, with a history of amenorrhea for 34 days. Case 2 was a pregnancy achieved by in vitro fertilization and embryo transfer (IVF-ET), with two fresh embryos transferred 21 days prior to admission. Preoperative ultrasound showed no intrauterine pregnancy, no obvious mass at the uterine cornua or adnexa, but revealed hemoperitoneum.
Intervention:
Both patients underwent emergency laparoscopy. Active bleeding from the tubal stump was identified, with no distinct mass visible. Case 1 received evacuation of pelvic hematocele, suture of the tubal stump and uterine cornua. Typical chorionic villi were identified in the pelvic hematocele. Case 2 underwent removal of one intact chorionic villus from the tubal stump surface, evacuation of pelvic hematocele with identification of a second chorionic villus, suture of the tubal stump and uterine cornua.
Outcomes:
Histopathological examination confirmed chorionic villi in the evacuated pelvic tissue. Primary implantation within the tubal stump wall could not be histologically confirmed. In Case 1, serial β-hCG levels declined steadily to within the normal range during follow-up. In Case 2, β-hCG increased during follow-up, consistent with persistent ectopic pregnancy(PEP), and the condition resolved after treatment with methotrexate (MTX).
Conclusion:
Abortive TSP is a rare and easily misdiagnosed condition. In post-salpingectomy patients with positive β-hCG and hemoperitoneum, consider TSP and/or abortive TSP; inspect the stump carefully and ensure structured postoperative β-hCG surveillance to detect persistent trophoblastic tissue.
